<!DOCTYPE html>
<html>
	<head>
		<meta charset="utf-8">
		<title></title>
	</head>
	<body>
		<form>
			<h3>New Member</h3>
			ID <input type="text" /><br />
			Password <input type="text" /><br />
			Re-Password <input type="text" /><br />
			<br />
			First Name <input type="text" /><br />
			Last Name <input type="text" /><br />
			Address <input type="text" /><br />
			City <input type="text" /><br />
			State
			<select>
				<option>[Select State]</option>
				<option>Georgia</option>
				<option>Hawaii</option>
				<option>Florida</option>
				<option>Texas</option>
				<option>Washington</option>
			</select><br />
			Country <input type="text" /><br />
			Email Address <input type="text" /><br />
			Select Interest
			<input type="checkbox" />Technology
			<input type="checkbox" />Enterprise
			<input type="checkbox" />Research
			<input type="checkbox" />Government
			<input type="checkbox" />People
			<input type="checkbox" />Life Style
			<input type="checkbox" />Opinion
			Question
			<select>
				<option>[Select Question]</option>
				<option>your father name</option>
				<option>city with kidden</option>
				<option>wish lover first</option>
				
			</select><br />
			Answer<input type="text" /><br />
		</form>
	</body>
</html>
